Healthcare Provider Details

I. General information

NPI: 1841267341
Provider Name (Legal Business Name): MOBRIDGE REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MAIN ST
TIMBER LAKE SD
57656
US

IV. Provider business mailing address

PO BOX 206
TIMBER LAKE SD
57656-0206
US

V. Phone/Fax

Practice location:
  • Phone: 605-865-3258
  • Fax:
Mailing address:
  • Phone: 605-865-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENAE TISDALL
Title or Position: CFO
Credential:
Phone: 605-845-8164